Dry eye and its correlation to diabetes microvascular complications in people with type 2 diabetes mellitus

Abstract

Aims

This study was performed to investigate the correlation between dry eye disease and diabetes microvascular complications.

Methods

In this study 243 people with type 2 diabetes were enrolled. Tear osmolarity was measured using tear lab osmolarity system. All of the participants were evaluated for diabetes microvascular complications. The Michigan neuropathy screening instrument was used for detection of peripheral neuropathy, and the albumin/creatinine ratio in a spot urine sample was considered to diagnose diabetic nephropathy.

Results

The prevalence of dry eye disease was 27.7%. The mean value for tear osmolarity was 301.97 ± 13.52 mOsm/L. We found a significant correlation between dry eye disease and diabetic retinopathy (P = 0.01). However no significant correlation was found between dry eye disease, diabetic neuropathy, and diabetic nephropathy.

Dry eye disease was more prevalent in people with proliferative diabetic retinopathy and/or clinically significant macular edema (0.006). In a binary logistic regression analysis model, there was a significant correlation between dry eye disease and retinopathy (OR = 2.29, CI = 1.16–4.52, P = 0.016). In addition, both dry eye and retinopathy had significant correlation with HbA1C.

Conclusions

Dry eye disease is common in people with type 2 diabetes, especially in those with diabetic retinopathy. In addition, it is more prevalent in people who suffer from advanced stages of diabetic retinopathy.

Introduction

Diabetes mellitus is a common systemic disease characterized by chronic hyperglycemia which leads to major chronic complications. Peripheral neuropathy, nephropathy, and retinopathy are well known microvascular complications of diabetes. A number of ocular complications accompany diabetes mellitus. These include cataract, glaucoma, retinopathy, punctuate keratitis, and recurrent corneal lesions (Inoue et al., 2001, Rehany et al., 2000). Diabetes is the leading cause of blindness in industrialized countries in people between the ages of 25 and 74 years and the fourth cause of blindness in developing countries (Robinson & News, 2012). Cataract, glaucoma, and macular degeneration are more likely to cause vision loss than diabetic retinopathy (Idil, Caliskan, & Ocaktan, 2004).

Dry eye disease (DED) is a common ocular disease among the adult population (Moss et al., 2000, Moss et al., 2004). Diabetic patients might exhibit dry eye symptoms probably due to neuropathy, metabolic dysfunction, or abnormal lacrimal secretions (Inoue et al., 2001, Dogru et al., 2001, Sánchez Thorin, 1998). It has been shown that the composition of tear proteins in diabetic people is different from healthy subjects (Herber et al., 2001, Herber et al., 2002, Grus et al., 2002). Damage to the microvasculature of the lacrimal gland accompanied with autonomic neuropathy might impair lacrimation in long standing diabetes mellitus. Patients with diabetic retinopathy do not complain of dry eye symptoms, however, they have clinical and pathological manifestations of Keratoconjunctivitis Sicca (KCS) (Nielsen & Lund, 1979). Several previous studies have investigated the relationship between dry eye disease, diabetes, and diabetic retinopathy (Moss et al., 2000, Seifart and Strempel, 1994, Manaviat et al., 2008, Nepp et al., 2000). However, the prevalence of DED varied according to the methods used for diagnosis of dry eye and it was not clear whether there is a correlation between DED and other microvascular complications of diabetes.

Our purpose was to investigate the prevalence of dry eye disease based on osmolarmeter as a gold standard method for diagnosis of tear hyperosmolarity and explore if peripheral neuropathy, nephropathy, and diabetic retinopathy have any correlation with dry eye disease in people with type 2 diabetes mellitus.